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1.
Ceska Gynekol ; 85(2): 104-110, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32527103

RESUMO

OBJECTIVE: To describe a case history of a patient after two caesarean sections, planning another pregnancy. Due to the dehiscent lower uterine segment, surgical correction of the defect was performed. Performance followed by an unplanned pregnancy five weeks after the operation. DESIGN: Case report. SETTING: Department of Obstetrics and Gynaecology, Hospital in Frýdek-Místek. CASE REPORT: We present a case of a 31-year-old third-graders, anamnestically after two caesarean sections, which were performed laparoscopical correction of isthmocoele in our department. Our patient was diagnosed with six weeks old intrauterine pregnancy only eleven weeks after surgery. The gravidity was successfully completed in the 38th week of pregnancy by the planned caesarean section with finding of a solid lower uterine segment. Whole duration of the pregnancy was uncomplicated. CONCLUSION: Women, after previous surgery of the uterus, are exposed to complications such as nidation disorders, placental disorders, risk of uterine rupture etc. during future pregnancy and childbirth. We want to show possible advantage of laparoscopic isthmocoele resection in combination with ventrosuspension of uterus.


Assuntos
Cesárea/efeitos adversos , Cicatriz/cirurgia , Laparoscopia/métodos , Aderências Teciduais/cirurgia , Doenças Uterinas/cirurgia , Útero/cirurgia , Adulto , Cicatriz/complicações , Cicatriz/patologia , Feminino , Humanos , Gravidez , Resultado da Gravidez , Aderências Teciduais/etiologia , Resultado do Tratamento , Doenças Uterinas/etiologia , Ruptura Uterina , Útero/patologia
2.
Medicine (Baltimore) ; 99(22): e20280, 2020 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-32481396

RESUMO

INTRODUCTION: Subchorionic hematoma (SCH) is a rare type of intrauterine hematoma, usually with limited impact on fetuses and pregnant women. But massive hematoma causes significant space occupying effect, affects blood supply of the fetus and finally may lead to fetus demise. PATIENT CONCERNS: In this case report, we reported a 22-year-old pregnant woman presented to our hospital with complaint of irregular lower abdominal pain. DIAGNOSIS: Ultrasonography and magnetic resonance imaging confirmed an intrauterine mass with a compressed growth-restricted fetus. INTERVENTIONS: The patient underwent diseases induced labor after confirmation of fetus demise by ultrasonography. OUTCOMES: Histopathological examination of the mass revealed a SCH. CONCLUSION: Though small SCH can be found in quite a few pregnant women and is usually harmless, enormous hematoma can result in adverse pregnancy outcomes. It may be difficult, in some cases, to differentiate it from uterine tumors or placental tumors by means of ultrasonography and magnetic resonance imaging, especially when the mass is hyperechoic under ultrasonography. This case report stresses the importance of regular examinations of pregnant women.


Assuntos
Retardo do Crescimento Fetal/patologia , Hematoma/patologia , Complicações na Gravidez/patologia , Doenças Uterinas/patologia , Feminino , Hematoma/diagnóstico , Humanos , Gravidez , Complicações na Gravidez/diagnóstico , Resultado da Gravidez , Primeiro Trimestre da Gravidez , Ultrassonografia Pré-Natal , Doenças Uterinas/diagnóstico , Adulto Jovem
3.
Medicine (Baltimore) ; 99(21): e20006, 2020 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-32481265

RESUMO

To review the results of a novel method of subtotal hysterectomy, called anterograde vaginal subtotal hysterectomy (AVSH), and to compare them with those of laparoscopic subtotal hysterectomy (LSH).We recruited 100 women with non-prolapsed uteruses and benign lesions of the uterus who required surgery. Of these, 60 underwent AVSH and 40 underwent LSH. Clinical data included average operation time, average volume of bleeding, postoperative anal exsufflation time, operative complications, average length of hospital stay and average hospital maintenance fee.There were no significant differences in terms of average operation time, average length of hospital stay, or operative complications between the AVSH and LSH groups. The AVSH group showed early postoperative anal exsufflation (P = .000), and had a low average hospital maintenance fee (P = .000). The AVSH group showed a higher perioperative bleeding volume than the LSH group (P = .001), which may be a result of the relatively amateur AVSH technique.AVSH is a minimally invasive, safe and feasible surgical procedure, with favorable early postoperative anal exsufflation and a low average hospital maintenance fee.


Assuntos
Histerectomia Vaginal/métodos , Doenças Uterinas/cirurgia , Adulto , Feminino , Humanos , Histerectomia/métodos , Laparoscopia , Pessoa de Meia-Idade , Resultado do Tratamento
4.
Yonsei Med J ; 61(4): 317-322, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32233174

RESUMO

PURPOSE: To evaluate factors associated with endometrial pathology during tamoxifen use in premenopausal breast cancer (BC) patients. MATERIALS AND METHODS: We reviewed the medical records of premenopausal BC patients treated with tamoxifen who underwent endometrial biopsy with or without hysteroscopy. Clinical characteristics were compared between women with endometrial pathology (endometrial hyperplasia or cancer) and those with normal histology or endometrial polyps. RESULTS: Among 284 endometrial biopsies, endometrial hyperplasia was diagnosed in 7 patients (2.5%), endometrial cancer was diagnosed in 5 patients (1.8%), normal histology was noted in 146 patients (51.4%), and endometrial polyp was present in 114 patients (40.1%). When comparing women with endometrial cancer (n=5) to women with normal histology, abnormal uterine bleeding was more common (p=0.007), and endometrial thickness was greater (p=0.007) in women with endometrial cancer. Chemotherapy for BC was also more common in patients with endometrial cancer (p=0.037). When comparing women with endometrial polyps and those with endometrial hyperplasia or cancer, the presence of abnormal uterine bleeding was more common in patients with endometrial hyperplasia or cancer (p<0.001); however, tamoxifen duration and endometrial thickness did not differ significantly between the two groups. CONCLUSION: In premenopausal BC patients treated with tamoxifen, abnormal uterine bleeding, increased endometrial thickness, and chemotherapy for BC were associated with the occurrence of endometrial cancer. These findings may provide useful information for gynecologic surveillance and counseling during tamoxifen treatment in premenopausal BC patients.


Assuntos
Antineoplásicos Hormonais/efeitos adversos , Neoplasias da Mama/tratamento farmacológico , Hiperplasia Endometrial/induzido quimicamente , Neoplasias do Endométrio/induzido quimicamente , Endométrio/efeitos dos fármacos , Pólipos/induzido quimicamente , Pré-Menopausa , Tamoxifeno/efeitos adversos , Adulto , Antineoplásicos Hormonais/uso terapêutico , Biópsia , Hiperplasia Endometrial/diagnóstico por imagem , Hiperplasia Endometrial/patologia , Neoplasias do Endométrio/diagnóstico por imagem , Neoplasias do Endométrio/patologia , Endométrio/diagnóstico por imagem , Endométrio/patologia , Feminino , Humanos , Histeroscopia , Pessoa de Meia-Idade , Pólipos/diagnóstico por imagem , Pólipos/patologia , Fatores de Risco , Tamoxifeno/uso terapêutico , Fatores de Tempo , Doenças Uterinas , Neoplasias Uterinas/induzido quimicamente , Neoplasias Uterinas/patologia
5.
Sci Total Environ ; 720: 137615, 2020 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-32325588

RESUMO

Endocrine-disrupting chemicals (EDCs) are natural/synthetic compounds that mimic or inhibit the biological actions of endogenous hormones. Studies have revealed that environmental estrogen, such as bisphenol A (BPA), causes developmental defects in the uterus. Tributyltin (TBT) is a typical environmental androgen. In this study, we aimed to explore the effect and mechanism of TBT on uterine development. Neonatal female rats were exposed to TBT (10 and 100 ng/kg bw) from postnatal days 1 to 16. BPA (50 µg/kg bw) was used as a positive control. Neonatal exposure to environmental concentrations of TBT resulted in pathological changes in the uterus, including thickening of the uterine luminal epithelium, a low density of glands, endometrial inflammation and fibrosis. Further, TBT affected the Wnt signaling pathway, which might mediate developmental disorders of the endometrial epithelial cells and glands in the uterus. TBT exposure also activated the NF-κB signaling pathway, which triggered inflammation. Moreover, TBT exposure upregulated the TGF-ß/Smads signaling pathway, possibly leading to endometrial fibrosis. In summary, our results demonstrate that neonatal exposure to an environment-relevant level of TBT leads to uterine dysplasia and provide potential molecular mechanisms. Our study is helpful for clarifying the effects of environmental androgens on the female reproduction system.


Assuntos
Útero , Animais , Animais Recém-Nascidos , Disruptores Endócrinos , Feminino , Ratos , Compostos de Trialquitina , Doenças Uterinas
6.
Radiol Clin North Am ; 58(2): 239-256, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32044005

RESUMO

Benign uterine diseases are common gynecologic conditions affecting women of all ages. Ultrasonography is traditionally the first-line imaging technique but patients are increasingly referred to magnetic resonance (MR) imaging because it is more accurate for diagnosis and patient management. This article highlights the added value of MR imaging in the diagnosis of the most common benign uterine diseases, describes therapeutic options, and delineates the role of MR imaging in treatment planning.


Assuntos
Imagem por Ressonância Magnética/métodos , Ultrassonografia/métodos , Doenças Uterinas/diagnóstico por imagem , Diagnóstico Diferencial , Feminino , Humanos , Doenças Uterinas/terapia , Útero/diagnóstico por imagem
7.
Int J Gynaecol Obstet ; 149(2): 192-196, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32012261

RESUMO

OBJECTIVE: To investigate the effect of early second-look office hysteroscopy combined with intrauterine balloon dilatation on prognosis and pregnancy rate for women with intrauterine adhesions. METHODS: A retrospective analysis of 156 women diagnosed with intrauterine adhesions by hysteroscopy at Shenyang Women's and Children's Hospital, China, from April 2017 to January 2019. The study women underwent intrauterine balloon dilatation 10 days after transcervical resection of adhesion (TCRA) and hysteroscopy 20 days after TCRA (n=81). The control women underwent hysteroscopy 3 months after TCRA (n=75). Estrogen and aspirin were routinely administered postoperatively to all women. Data, including American Fertility Society (AFS) scores assessed by hysteroscopy, endometrial thickness measured by ultrasound, and menstruation and pregnancy outcomes assessed by interview, were compared between the two groups. RESULTS: The degree of intrauterine adhesions, menstrual status, and endometrial thickness were improved in both groups after TCRA. Greater improvement in AFS score, menstruation, and endometrial thickness was observed in the study group than in the control group. After follow-up, more women in the study group achieved pregnancy (48.1% vs 30.7%, P<0.05). CONCLUSION: Early second-look of hysteroscopy combined with intrauterine balloon dilatation after hysteroscopic TRCA might improve the prognosis and postoperative pregnancy rate for women with intrauterine adhesions.


Assuntos
Histeroscopia/métodos , Aderências Teciduais/cirurgia , Tamponamento com Balão Uterino/métodos , Doenças Uterinas/cirurgia , Adulto , Estudos de Casos e Controles , China , Feminino , Humanos , Menstruação/fisiologia , Gravidez , Taxa de Gravidez , Estudos Retrospectivos , Cirurgia de Second-Look/instrumentação
8.
Braz J Med Biol Res ; 53(3): e9058, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32077466

RESUMO

The objective of this study was to evaluate changes in sexual function after total laparoscopic hysterectomy (TLH) or transabdominal hysterectomy (TAH). This retrospective cohort study included patients with benign uterine tumors that were divided into TLH group and TAH group based on the hysterectomy technique used. Baseline, intraoperative, and postoperative characteristics were compared between groups. Postoperative sexual function was assessed using the Brief Index of Sexual Functioning for Women. The TLH and TAH groups contained 119 patients (age, 51.5±6.1 years) and 126 patients (age, 50.0±4.7 years), respectively. Baseline characteristics were comparable between groups, although uterine size was larger in the TAH group (P<0.001). Compared with the TAH group, the TLH group had a longer operative time (130.0±36.2 vs 107.3±28.5 min, P<0.001), lower pain index at 24 h (2.0±1.6 vs 4.0±2.6, P<0.001), and shorter hospitalization time (5.7±1.1 vs 8.1±1.2 days, P<0.001). Many patients in the TLH and TAH groups reported decreased satisfaction with their sexual life (67.5 and 56.0%, respectively), reduced frequency of sexual activity (70.1 and 56.0%, respectively), decreased libido (67.5 and 56.0%, respectively), orgasm dysfunction (42.9 and 42.9%, respectively), and increased dyspareunia (77.9 and 85.7%, respectively). However, there was no significant difference between groups in any of the indexes of postoperative sexual function (P>0.05). Both TLH and TAH had comparable negative effects on sexual function in women treated for benign uterine tumors in China, with a decreased frequency of sexual activity, reduced libido, orgasm dysfunction, and increased dyspareunia.


Assuntos
Disfunções Sexuais Fisiológicas , Saúde Sexual , Doenças Uterinas/cirurgia , Adulto , Estudos de Coortes , Feminino , Humanos , Histerectomia , Laparoscopia , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Retrospectivos , Doenças Uterinas/psicologia
9.
J Chromatogr A ; 1618: 460869, 2020 May 10.
Artigo em Inglês | MEDLINE | ID: mdl-31959456

RESUMO

Prostaglandins (PGs) are vitally important unsaturated fatty acids involved in arachidonic acid (AA) metabolism, participating in numerous pathophysiological processes, especially in maintaining the homeostasis of uterus. Therefore, quantitative analysis of PGs is of great importance for uncovering potential mechanisms of PGs related diseases. However, methods for determining PGs in uterine samples have not been reported. In this study, an ultra high-performance liquid chromatography/mass spectrometry (UHPLC-MS/MS) method was established to quantify PGs in uterine samples, using N,N-Dimethylethylenediamine (DMED) and N,N-Diethylethylenediamine (DEED) as derivatization reagents. The derivatization could be finished at 37 °C for 30 min catalyzed by 1-N,N,N',N'-Tetramethyl-O-(7-azabenzotriazol-1-yl) uronium hexafluorophosphate (HATU). This is a mild condition suitable for most of biological samples. The DMED labeling of PGs could significantly enhance their response compared to those of underived ones. This method exhibited excellent linearity (R2 > 0.997) and precision for the determination of PGs in uterine samples (CV ≤ 12.9%). The extraction recoveries of PGs were ranged from 83.0 to 100% and matrix effects were ranged from 86.3 to 106%, indicating DEED labeled standards could be used as internal standards for PGs quantification. With the proposed method, we successfully quantified PGs in rat uterus. The results showed their levels were significant changed in abnormal uterine bleeding (AUB) rats, suggesting that PGs might be involved in the pathological process of AUB. This established analogous reagents derivatization based UHPLC-MS/MS method could be used as a powerful tool to monitor PGs, providing insights to the precise mechanism of PG action on the endometrium.


Assuntos
Técnicas de Química Analítica/métodos , Cromatografia Líquida de Alta Pressão , Prostaglandinas/análise , Espectrometria de Massas em Tandem , Útero/química , Animais , Feminino , Indicadores e Reagentes/química , Ratos , Doenças Uterinas/fisiopatologia , Útero/fisiopatologia
10.
Arch Gynecol Obstet ; 301(1): 33-52, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31989288

RESUMO

PURPOSE: To investigate the effectiveness and risks of different surgical therapies for isthmocele in symptomatic women with abnormal uterine bleeding, infertility, or for the prevention of obstetric complications, considering safety and surgical complications. METHODS: PubMed/MEDLINE, Scopus, Embase, Science Direct, and Cochrane Library were systematically searched (n° CRD4201912035) for original articles on the surgical treatment of isthmocele published between 1950 and 2018. Data synthesis was completed using MedCalc 16.4.3. The body of evidence was assessed using the GRADE methodology. RESULTS: We retrieved 33 publications: 28 focused on a single surgical technique, and five comparing different techniques. Meta-analysis showed an improvement of symptoms in 85.00% (75.05-92.76%) of women after hysteroscopic correction, 92.77% (85.53-97.64%) after laparoscopic/robotic correction, and 82.52% (67.53-93.57%) after vaginal correction. Hysteroscopic surgery was associated with the lowest risk of complications (0.76%, 0.20-1.66%). CONCLUSIONS: We found adequate evidence supporting the use of surgery for the treatment of symptomatic isthmocele, as it was found to improve the bleeding symptoms in more than 80% of patients. Differently, we found a lack of evidence regarding the role of surgery with the purpose of improving fertility or reducing the risk of obstetric complications in women with asymptomatic isthmocele. The hysteroscopic correction of isthmocele may be the safest and most effective strategy in those patients with adequate residual myometrial thickness overlying the isthmocele. Laparoscopic and vaginal surgeries may be the preferred options for patients with a thinner residual myometrium over the defect (< 2.5 mm) and when hysteroscopic treatment is inconclusive.


Assuntos
Cicatriz/cirurgia , Doenças Uterinas/cirurgia , Cicatriz/patologia , Feminino , Humanos , Histeroscopia/métodos , Laparoscopia/métodos
11.
Am J Obstet Gynecol ; 222(6): 584.e1-584.e5, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31981513

RESUMO

While uterus transplantation was once considered only a theoretical possibility for patients with uterine factor infertility, researchers have now developed methods of transplantation that have led to successful pregnancies with multiple children born to date. Because of the unique and significant nature of this type of research, it has been undertaken with collaboration not only with scientists and physicians but also with bioethicists, who paved the initial path for research of uterus transplantation to take place. As the science of uterus transplantation continues to advance, so too must the public dialogue among obstetrician/gynecologists, transplant surgeons, bioethicists, and other key stakeholders in defining the continued direction of research in addition to planning for the clinical implementation of uterus transplantation as a therapeutic option. Given the rapid advances in this field, the time has come to revisit the fundamental questions raised at the inception of uterus transplantation and, looking forward, determine the future of this approach given emerging data on the procedure's impact on individuals, families, and society.


Assuntos
Infertilidade Feminina/cirurgia , Transplante de Órgãos/ética , Útero/transplante , Transtornos 46, XX do Desenvolvimento Sexual/complicações , Atitude Frente a Saúde , Cesárea , Anormalidades Congênitas , Transferência Embrionária , Feminino , Rejeição de Enxerto/prevenção & controle , Acesso aos Serviços de Saúde , Humanos , Histerectomia , Imunossupressores/uso terapêutico , Infertilidade Feminina/etiologia , Infertilidade Feminina/psicologia , Cobertura do Seguro , Seguro Saúde , Ductos Paramesonéfricos/anormalidades , Transplante de Órgãos/economia , Transplante de Órgãos/legislação & jurisprudência , Transplante de Órgãos/psicologia , Preferência do Paciente , Aderências Teciduais/complicações , Obtenção de Tecidos e Órgãos , Doenças Uterinas/complicações
12.
Gynecol Oncol ; 156(2): 387-392, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31787246

RESUMO

OBJECTIVE: We aimed to assess whether endometrial cancer (EC) can be detected in shed DNA collected with vaginal tampon by analyzing copy number, methylation markers, and mutations. METHODS: Tampons were collected prior to hysterectomy from 38 EC patients and 28 women with benign indications. Extracted tampon DNA underwent the following: 1) low-coverage whole genome sequencing (LC-WGS) to assess copy number, 2) pyrosequencing to measure percent promotor methylation of HOXA9, RASSF1, and CDH13 and 3) next generation sequencing (NGS) to identify mutations in 19 genes associated with EC identified through The Cancer Genome Atlas. Sensitivity and specificity for each test and test combinations were calculated. RESULTS: Methylation analysis yielded the highest specificities but lowest sensitivities (37-40% sensitivity; 100% specificity for HOXA9, RASSF1 and HTR1B) while mutation analysis had improved sensitivity (50% sensitivity; 83% specificity). Only one "false positive" result for copy number variants was identified among women with benign surgical indications, which was based on detection of copy number changes, and associated with a leiomyosarcoma that was only recognized at hysterectomy. Considering any of the 3 biomarker classes as a positive, resulted in a sensitivity of 92% and specificity of 86%. Mutation analysis did not add sensitivity to the combination of analysis of copy number and methylation. CONCLUSIONS: This study demonstrates a proof-of-principle for non-invasive yet precise detection of endometrial cancer. We propose that with improved biomarker testing, it may be possible to develop a clinically useful test for detecting EC.


Assuntos
Metilação de DNA , Neoplasias do Endométrio/genética , Dosagem de Genes , Produtos de Higiene Menstrual , Biomarcadores Tumorais/genética , Diagnóstico Diferencial , Neoplasias do Endométrio/diagnóstico , Neoplasias do Endométrio/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Mutação , Doenças Uterinas/diagnóstico , Doenças Uterinas/genética , Doenças Uterinas/patologia , Esfregaço Vaginal/métodos
14.
Einstein (Sao Paulo) ; 18: eAO4916, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31851226

RESUMO

OBJECTIVE: To investigate the prevalence and intensity of pain perception during diagnostic hysteroscopy in women and potential related factors. METHODS: A total of 489 women were investigated at an infertility clinic. Fluid diagnostic hysteroscopy was performed without analgesia or anesthesia by gynecologists with different levels of experience in operative hysteroscopy, using a 2.9mm rigid scope. The Visual Analog Scale was used to score pain intensity after vaginal speculum insertion and after hysteroscopy. Data collected included age, ethnicity, body mass index, history of infertility and endometrial surgery (curettage and/or hysteroscopy), smoking habits, and hysteroscopy diagnosis. Only the state of anxiety was assessed by the State-Trait Anxiety Inventory given to each patient before the procedure. RESULTS: Hysteroscopy median (25th to 75th) Visual Analog Scale scored 3.3 (3 to 5), and 41.7% of the women referred Visual Analog Scale score ≥4. Median (25th to 75th) State-Trait Anxiety Inventory score was 42 (38 to 45), and 58.3% of the women referred State-Trait Anxiety Inventory score >40. Hysteroscopy Visual Analog Scale score was significantly correlated to surgeon experience and to vaginal speculum insertion but not to State-Trait Anxiety Inventory score, ethnicity or abnormal hysteroscopic findings. CONCLUSION: Diagnostic hysteroscopy was mostly perceived as a mild discomfort procedure by most women. Nevertheless, in a considerable number of cases, women perceived hysteroscopy as painful. Pain perception was linked to individual pain threshold and surgeon experience, but not to pre-procedural anxiety state levels, ethnicity or abnormal hysteroscopic findings.


Assuntos
Histeroscopia/efeitos adversos , Medição da Dor/estatística & dados numéricos , Percepção da Dor , Dor Processual/epidemiologia , Dor Processual/etiologia , Adulto , Ansiedade/psicologia , Índice de Massa Corporal , Brasil/epidemiologia , Feminino , Clínicas de Fertilização , Humanos , Histeroscopia/psicologia , Pessoa de Meia-Idade , Medição da Dor/psicologia , Dor Processual/psicologia , Pólipos/cirurgia , Prevalência , Escalas de Graduação Psiquiátrica , Valores de Referência , Estatísticas não Paramétricas , Doenças Uterinas/cirurgia , Escala Visual Analógica , Adulto Jovem
15.
J Dairy Sci ; 103(1): 666-675, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31733846

RESUMO

In a subset of dairy cows, prolonged pathological uterine inflammation results in purulent vaginal discharge (PVD), which can have negative consequences for both fertility and milk production. However, unlike for intensive systems, analysis of the effects of PVD in predominantly pasture-based herds is limited. The objective of this study was to assess the effect of PVD in spring-calving, pasture-based dairy cows on production and reproduction indices, stratified according to previous full-lactation milk yield. We assessed clinical disease as defined by vaginal mucus score (VMS) in 440 Holstein-Friesian cows from 5 farms. Cows were categorized as healthy (VMS 0) or having PVD (VMS 1-3) at 21 d postpartum. We recorded 305-d milk, milk protein, and milk fat yields (kg) before and after disease diagnosis, as well as fertility data, such as services per conception and the calving-conception period (CCP). Using SAS 9.4 (SAS Institute Inc., Cary, NC), we analyzed data using PROC MIXED, PROC PHREG, and PROC LOGISTIC to determine the least squares means differences and hazard and odds ratios between the groups, respectively. Overall, a 60% prevalence of PVD was recorded at 21 d postpartum. Milk yield and milk constituents were similar between all VMS categories and between healthy cows and cows with PVD. Although cows in the 4 VMS categories had statistically similar CCP, cows with PVD had a significantly longer CCP than healthy cows on average (9 d). The hazard ratio for cows with PVD was 0.66, indicating a 34% higher risk of a prolonged CCP than healthy cows. Odds ratio analysis determined that cows with PVD were 3 times more likely not to conceive at all, twice as likely not to conceive at first service, twice as likely not to conceive by 100 d postpartum, and 3 times more likely to fail to conceive before 150 d postpartum compared with healthy cows. Cows were retrospectively categorized as having low or high milk yield, based on whether they were above or below the median 305-d milk yield of the study population (6,571 kg) in the lactation before vaginal mucus scoring. Based on a univariate odds ratio, high-yield cows were 1.6 times more likely to present with PVD in the subsequent lactation. The number of services per conception did not differ between healthy and PVD cows in the low- and high-yield groups. In the high-yield group, cows with PVD were 4.9 times more likely not to conceive, 2.7 times more likely to require multiple services to conceive, 2.1 times more likely to remain not pregnant by 100 d postpartum, and 4.4 times more likely to remain not pregnant by 150 d postpartum. The CCP was also significantly longer in cows with PVD than their healthy counterparts (115.9 ± 4.9 and 104 ± 7.4 d, respectively). In conclusion, PVD significantly increased the CCP in all cows, but to a greater extent in cows with a high milk yield in the lactation before disease diagnosis.


Assuntos
Doenças dos Bovinos/etiologia , Fertilidade , Lactação , Descarga Vaginal/veterinária , Animais , Bovinos , Doenças dos Bovinos/diagnóstico , Feminino , Leite , Proteínas do Leite/metabolismo , Período Pós-Parto , Gravidez , Reprodução , Estudos Retrospectivos , Estações do Ano , Doenças Uterinas/fisiopatologia , Doenças Uterinas/veterinária , Descarga Vaginal/diagnóstico
16.
Arch Gynecol Obstet ; 301(1): 199-205, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31883044

RESUMO

PURPOSE: To evaluate whether the cross-linked hyaluronan (cHA) gel can improve the clinical pregnancy rate of patients with moderate to severe intrauterine adhesion (IUA) who underwent operative hysteroscopy followed by embryo transfer. METHODS: Women with moderate to severe IUA desiring to undergo embryo transfer were recruited in this randomized controlled trial. The patients were randomized on the day of receiving hysteroscopy. The control group received standard hysteroscopy, while cHA gel was applied to the treatment group at the end of hysteroscopy and 5-7 days after operation. All patients were expected to undergo in vitro fertilization (IVF)/intracytoplasmic sperm injection and frozen-thawed embryo transfer (FET). RESULTS: A total of 306 patients were enrolled in this study, of which 202 were assigned to the treatment group and 104 to the control group. Both the clinical pregnancy rate (26.3% [49/186] vs. 15.3% [13/85], P = 0.045), the implantation rate (17.7% [57/322] vs. 9.8% [15/153], P = 0.025), and the endometrial thickness on the day of embryo transfer (7.97 ± 1.37 vs. 7.50 ± 0.60 mm, P < 0.001) were significantly higher in the treatment group compared to the control group. In addition, histological assessment of the paired endometrial tissues collected before and after operation revealed a relatively higher number of tubular glands after operation (15.1 ± 13.2 vs. 28.8 ± 30.4, P = 0.166). CONCLUSIONS: To conclude, the application of cHA gel in patients with moderate to severe IUA during hysteroscopy can improve the quality of endometrium and uterine receptivity and consequently enhance the clinical pregnancy rate after IVF/CSI and FET.


Assuntos
Transferência Embrionária/métodos , Fertilização In Vitro/métodos , Ácido Hialurônico/uso terapêutico , Taxa de Gravidez/tendências , Doenças Uterinas/tratamento farmacológico , Adulto , Feminino , Humanos , Ácido Hialurônico/farmacologia , Gravidez , Estudos Prospectivos , Resultado do Tratamento
17.
BMJ Case Rep ; 12(12)2019 Dec 05.
Artigo em Inglês | MEDLINE | ID: mdl-31811107

RESUMO

Uterocutaneous fistula is an extremely rare clinical condition that may be caused by postoperative or postpartum complications, such as infection or inflammation. Although fibroids and myomectomy are common clinical entities among women of reproductive age, there are very few postmyomectomy uterocutaneous fistula cases in the literature. This article presents the first reported case of a succesful pregnancy and live birth following treatment of a postmyomectomy uterocutaneous fistula. After laparoscopic adhesiolysis, a minilaparotomy was performed to excise the fistula tract completely from both the abdominal wall and the uterus. The uterine wall defect was repaired in multiple layers. The patient had a good recovery after surgery, and the uterocutaneous fistula resolved completely. Due to obliteration of both tubal ostia, the patient was referred for in vitro fertilisation treatment. She conceived after the third frozen embryo transfer procedure and gave birth to a 4.4 kg baby at full term by caesarean section.


Assuntos
Fístula Cutânea/diagnóstico , Fístula/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Doenças Uterinas/diagnóstico , Miomectomia Uterina , Adulto , Fístula Cutânea/cirurgia , Diagnóstico Diferencial , Feminino , Fístula/cirurgia , Humanos , Complicações Pós-Operatórias/cirurgia , Gravidez , Resultado da Gravidez , Doenças Uterinas/cirurgia
18.
Acta Clin Croat ; 58(2): 249-254, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31819320

RESUMO

The aim of our retrospective study was to compare the performance of transvaginal sonography in relation to histologic diagnosis of samples obtained by hysteroscopy through analysis of data collected over 16 years. Data on suspected formation of endometrial polyp or submucosal fibroid found on ultrasound examination were extracted. The study included a total of 3679 women examined during the 2000-2015 period. All women underwent ultrasound examination preoperatively for better planning the type and scope of operation to be performed. The study included only women with samples for histopathologic analysis collected during the operation. Ultrasound diagnosis of polyps compared with histology showed 89.6% sensitivity and 39.1% specificity. For submucosal myomas, sensitivity was 69.2% and specificity 91.3%. In conclusion, ultrasound is not reliable method for definitive diagnosis but it is an excellent orientation method.


Assuntos
Endométrio/diagnóstico por imagem , Histeroscopia/métodos , Ultrassonografia/métodos , Doenças Uterinas/diagnóstico , Doenças Uterinas/fisiopatologia , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/fisiopatologia , Adulto , Croácia , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade
19.
J Exp Ther Oncol ; 13(2): 125-129, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31881128

RESUMO

Objective: We searched thiol/disulphide homeostasis and ischemia modified albumin (IMA) in patients with and without endometrial polyp (EP) to evaluate whether there is an association between serum oxidative stress markers and EPs. Methods: A total of 87 women were enrolled into this study. All patients were evaluated with office hysteroscopy, and then those with EPs underwent operative hysteroscopy. 43 of these women had pathologically confirmed EPs (study group) and 44 had not (control group). Fasting blood samples were obtained from the antecubital vein before the procedure in all women. Thiol/disulphide levels were analyzed with a newly developed method by Erel et al. IMA measurement was performed using an indirect method based on the colorimetric assay as previously defined. Results: There were no significant differences between the 2 groups in terms of demographic characteristics including age, body mass index, and past obstetric history. Similarly no significant difference was observed regarding infertility ratio and smoking status. Native thiol, total thiol, and disulphide levels were found to be 263.6±63.3 µmol/l vs. 280.9±63.8 µmol/l (p:0.208), 296.9±64.9 µmol/l vs. 315.2±67.3 µmol/l (p:0.202), and 16.6±6.5 µmol/l vs.17.1±7.8 µmol/l ( p:0.759) in the study and control groups, respectively. There was also no significant difference with regard to serum IMA level (46.5±12.1 vs. 44.9±12.6; p: 0.539). Conclusion: Serum thiol/disulphide homeostasis and IMA levels have no significant effect in the pathogenesis of EPs.


Assuntos
Dissulfetos , Homeostase , Estresse Oxidativo , Pólipos , Albumina Sérica , Doenças Uterinas , Biomarcadores , Estudos de Casos e Controles , Feminino , Humanos , Pólipos/metabolismo , Gravidez , Compostos de Sulfidrila , Doenças Uterinas/metabolismo
20.
BMC Pregnancy Childbirth ; 19(1): 408, 2019 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-31703641

RESUMO

BACKGROUND: Incarceration of the gravid uterus is a rare obstetric disorder that contributes to pregnancy-related complications. To understand its clinical characteristics and managements, we have reviewed the etiology, risk factors, clinical characteristics and current treatments of an incarcerated gravid uterus based on 162 cases reported in the English language literature, including our patient. CASE PRESENTATION: A 25-year-old primigravida, with a history of lymphatic tuberculosis, infertility due to blocked fallopian tubes and received in vitro fertilization. The patient presented with urine retention and lower abdominal pain in the early second trimester. Uterine incarceration was diagnosed based on pelvic examination and abdominal ultrasound. A Foley catheter was placed and manual reposition was successful. No episode of retention was experienced after the further enlargement of the uterus and its ascent. A healthy infant was delivered vaginally on 38th week of pregnancy. CONCLUSIONS: Uterine incarceration due to pelvic adhesions is rare and, because of it non-specific clinical presentations, is often misdiagnosed. Abdominal ultrasound is instrumental for the diagnosis because it can directly image the disturbed uterine and pelvic anatomy. There are limited treatment options for uterine incarceration, but definitive diagnosis allows procedures to treat and to reduce severe complications of uterine incarceration.


Assuntos
Complicações na Gravidez , Doenças Uterinas/diagnóstico , Útero/diagnóstico por imagem , Adulto , Feminino , Humanos , Recém-Nascido , Pelve , Gravidez , Segundo Trimestre da Gravidez , Ultrassonografia Pré-Natal
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